VA Boston Healthcare System and Boston University, Boston, MA, USA.
J Am Coll Surg. 2011 Sep;213(3):363-9. doi: 10.1016/j.jamcollsurg.2011.05.008. Epub 2011 Jun 15.
Hernia characteristics and patient factors associated with acute compared with elective groin hernia surgery are unknown.
A retrospective study of 1,034 consecutive groin hernia repair cases performed between 2001 and 2009 at a single Veterans Affairs Hospital was conducted. Patient variables, hernia characteristics, time to surgery, and morbidity and mortality outcomes were abstracted and compared between acute and elective hernia repairs. A Kaplan-Meier survival analysis for the two groups was also performed. Logistic regression analysis was conducted to identify associations between type of surgery, patient demographics, and hernia characteristics.
Compared with 971 elective repair patients, the 63 acute repair patients had a higher rate of femoral hernias (2.5% vs 7.4%, p = 0.03), a higher rate of scrotal hernias (16.2% vs 32.4%, p = 0.0006), and a higher rate of recurrent hernias (16.7% vs 30.9%, p = 0.0026). Patient age, femoral, scrotal, and recurrent hernias were significantly associated with acute hernia presentation on univariate and multivariable analyses. Complications occurred in 27% and 15.1% of acute and elective repair patients, respectively (p = 0.01). Intraoperative organ resection was required in 7 (11.1%) acute hernia repairs, and in 2 (0.2%) elective repairs (p < 0.0001). Three acute repair patients (4.8%) underwent reoperation within 30 days after surgery, compared with 15 elective repair patients (1.5%), p = 0.05. Age-adjusted Kaplan-Meier survival analysis revealed a shorter time to death among acute repair patients compared with elective repair patients (p < 0.0001).
Age, femoral, scrotal, and recurrent groin hernias are associated with increased risk for acute hernia surgery. Acute hernia repair carries a higher morbidity and lower survival.
与择期腹股沟疝手术相比，急性腹股沟疝手术的疝特征和患者因素尚不清楚。
对 2001 年至 2009 年期间在一家退伍军人事务医院进行的 1034 例连续腹股沟疝修补术进行回顾性研究。提取患者变量、疝特征、手术时间以及发病率和死亡率结果，并在急性和择期疝修补术之间进行比较。对两组进行 Kaplan-Meier 生存分析。进行逻辑回归分析以确定手术类型、患者人口统计学和疝特征之间的关联。
与 971 例择期修复患者相比，63 例急性修复患者中股疝发生率较高（2.5%对 7.4%，p=0.03），鞘膜疝发生率较高（16.2%对 32.4%，p=0.0006），复发性疝发生率较高（16.7%对 30.9%，p=0.0026）。在单变量和多变量分析中，患者年龄、股疝、鞘膜疝和复发性疝与急性疝表现显著相关。并发症分别发生在 27%和 15.1%的急性和择期修复患者中（p=0.01）。7 例（11.1%）急性疝修复术需要术中切除器官，2 例（0.2%）择期修复术需要切除器官（p<0.0001）。3 例（4.8%）急性修复患者在手术后 30 天内再次手术，而 15 例（1.5%）择期修复患者再次手术，p=0.05。年龄调整的 Kaplan-Meier 生存分析显示，急性修复患者的死亡时间短于择期修复患者（p<0.0001）。
年龄、股疝、鞘膜疝和复发性腹股沟疝与急性疝手术风险增加相关。急性疝修复术的发病率较高，生存率较低。
